Search

Acid-base status is frequently assessed in severe sepsis and septic shock. Venous blood gas sampling is proposed as a less-invasive modality but lacks evidence within this population. The objective of this study was to evaluate the correlation and agreement between arterial blood gas (ABG), peripheral venous blood gas (pVBG), and central venous blood gas (cVBG) in severe sepsis and septic shock. We conducted a prospective, observational cohort study in subjects admitted to the medical intensive care unit. Simultaneous blood gas samples, including ABG, pVBG, and cVBG, were analyzed for correlation and agreement. Severity of illness scores revealed a mean (±SD) Sequential Organ Failure Assessment score of 7.9 ± 3.3, Simplified Acute Physiology II score of 49.3 ± 16.5, and a mortality rate of 11.9% in the intensive care unit and 16.4% in the hospital. We found a strong intraclass correlation (>0.85) for pH, partial pressure of carbon dioxide (pCO2), bicarbonate, and base excess for ABG/pVBG, ABG/cVBG, and pVBG/cVBG comparisons. Agreement by the Bland-Altman method was found for pH (bias ± SD, 0.03 ± 0.04, 0.03 ± 0.02, and 0.00 ± 0.03) but not for pCO2, partial pressure of oxygen, bicarbonate, base excess, and oxyhemoglobin saturation. In conclusion, adequate correlation and agreement between ABG/pVBG, ABG/cVBG, and pVBG/cVBG comparisons was found only for pH. The current level of evidence does not support the use of venous blood gas sampling in this setting. [ABSTRACT FROM AUTHOR]

Cardiogenic pulmonary edema classically presents bilaterally and with a symmetric distribution. Occasionally, cardiogenic pulmonary edema can present unilaterally, which carries an independent risk for mortality, possibly due to the delayed diagnosis. The most common cardiogenic cause of unilateral pulmonary edema is acute mitral regurgitation, frequently described in the setting of acute coronary syndrome. Here we describe a case of unilateral pulmonary edema caused by acute mitral regurgitation outside the setting of acute coronary syndrome. [ABSTRACT FROM AUTHOR]

This article explores the common ground and reciprocity between interprofessional practice and action research. The emphasis is focused upon health and social care but generalisations are formulated which could be applied to other areas where collaboration between professionals is important. [ABSTRACT FROM PUBLISHER]

The authors led an activity therapy group for elementary school aged girls in an ethnically integrated neighborhood for two and one-half years. All of these girls experienced various family losses due to death, divorce, immigration and other disruptions. This paper describes the formation, structure, process and evaluation of the group. [ABSTRACT FROM PUBLISHER]

A review and synthesis of the literature and current events reveal that we are living in an age of divorce and remarriage. Stepfamilies and step relationships are a recurring entity in American society. Furthermore, record numbers of individuals are involved in complex step relationships for which they are often unprepared and ineffectively coping. Society's tendency to place a premium on the nuclear family creates aspecial burden for the stepfamily and the relationships therein. Awkward descriptive problems, confused kinship patterns, and conflicting roles and allegiances tend to contribute to a feeling of deviancy among members of stepfamilies which, in turn, complicates adjustment and interpersonal relationships. Remarriage generally creates confusion and anxiety among all members of a stepfamily but is especially stressful for the adolescent and the stepmother. This article reveals some of the current trends, practices, and problems of remarriage. The impact of these social patterns on members of a stepfamily will be discussed. [ABSTRACT FROM PUBLISHER]

A 35-year-old woman with previously untreated latent tuberculosis was admitted to the hospital for management of a right-sided empyema. After a prolonged hospitalization and several interventions, including chest tubes, bronchoscopy with bronchoalveolar lavage, and a video-assisted thoracoscopic surgery, positive acid-fast bacilli cultures on the initial thoracentesis ultimately led to the diagnosis of pleural tuberculosis. This case highlights the importance of utilizing a combination of diagnostic tests to diagnose pleural tuberculosis, especially in the setting of a negative pleural adenosine deaminase level. [ABSTRACT FROM AUTHOR]